pN status in adenocarcinoma of the distal oesophagus and cardia (ADOC).
Objectives Adenocarcinoma of the distal oesophagus and cardia (ADOC) are grouped among the thoracic tumors according to the TNM 7~ ed., however controversy is pending on the unique or dual pathogenesis (GORD or gastric-like cancerogenesis). We investigated the pathways of Iymphatic spreading in two cohorts of ADOC with or without Barrett's metaplasia. Methods ADOC + Barrett's (group 1) was diagnosed in 54 (subtotal oesophagectomy and oesophagogastrostomy at the neck or chest dome); no Barrett's was detected in 140 ADOC (group 2), (oesophagectomy at the azygos vein + total gastrectomy with Roux oesphagojejunostomy). A11 194 cases, were approached through a right thoracotomy and upper laparotomy. Radical Iymphadenectomy (stations 4L/R-34-7-10-8-9-15-16-17-18-19-20 TNM 7th ed. + pancreatic and pyloric nodes) was identical in both procedures except for the greater curvature stations. Results Histology confirmed the preop. Barrett-non Barrett grouping. Groups I and 2 were not different (p>0,05) for sex, age, mortality, morbidity, R0 resection rate and grading. They were different (p<0,05) for the number of patients with positive nodes (27/54 50% in group I and 98/140 70% in group 2), stage I (13/54 24% in group I and 4/140 3% in group 2), stage 3a4 (5/54 9°/O in group I and 44/140 31% in group 2). Median number (IQR) of resected nodes was 29 (15-36.5) in I and 30 (20-40) in 2 (p=.5 1). Distribution of pN+ and site of recurrence are reported in table 1. Survival of group I and 2 at Syrs is 42%, at 10yrs is 41% for group 1 and 36% for group 2 (log-rank p=0,679). Conclusions ADOC with Barrett's spreads preferentially to the thoracic stations opposite to ADOC without Barrett's which involves mostly perigastric nodes comprising the greater curvature's in 16.5%. The role of total gastrectomy should be questioned. These data deserve further investigation to improve surgery but possibly also surveillance programs. Disclosure: All authors have declared no conflicts of interest.
PN Status in adenocarcinoma of the distal oesophagus and cardia (ADOC) / Ruffato, Alberto; Aramini, Beatrice; D'Errico, Antonietta; Lugaresi, Marialuisa; Malvi, D; Guiducci, Gm; Mattioli, Sandro. - In: INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY. - ISSN 1569-9293. - (2011). (Intervento presentato al convegno XXIV Congresso Nazionale S.P.I.G.C. Società Polispecialistica Italiana dei Giovani Chirurghi. tenutosi a Napoli nel 13-16 Ottobre 2011).
PN Status in adenocarcinoma of the distal oesophagus and cardia (ADOC).
ARAMINI BEATRICE;
2011
Abstract
Objectives Adenocarcinoma of the distal oesophagus and cardia (ADOC) are grouped among the thoracic tumors according to the TNM 7~ ed., however controversy is pending on the unique or dual pathogenesis (GORD or gastric-like cancerogenesis). We investigated the pathways of Iymphatic spreading in two cohorts of ADOC with or without Barrett's metaplasia. Methods ADOC + Barrett's (group 1) was diagnosed in 54 (subtotal oesophagectomy and oesophagogastrostomy at the neck or chest dome); no Barrett's was detected in 140 ADOC (group 2), (oesophagectomy at the azygos vein + total gastrectomy with Roux oesphagojejunostomy). A11 194 cases, were approached through a right thoracotomy and upper laparotomy. Radical Iymphadenectomy (stations 4L/R-34-7-10-8-9-15-16-17-18-19-20 TNM 7th ed. + pancreatic and pyloric nodes) was identical in both procedures except for the greater curvature stations. Results Histology confirmed the preop. Barrett-non Barrett grouping. Groups I and 2 were not different (p>0,05) for sex, age, mortality, morbidity, R0 resection rate and grading. They were different (p<0,05) for the number of patients with positive nodes (27/54 50% in group I and 98/140 70% in group 2), stage I (13/54 24% in group I and 4/140 3% in group 2), stage 3a4 (5/54 9°/O in group I and 44/140 31% in group 2). Median number (IQR) of resected nodes was 29 (15-36.5) in I and 30 (20-40) in 2 (p=.5 1). Distribution of pN+ and site of recurrence are reported in table 1. Survival of group I and 2 at Syrs is 42%, at 10yrs is 41% for group 1 and 36% for group 2 (log-rank p=0,679). Conclusions ADOC with Barrett's spreads preferentially to the thoracic stations opposite to ADOC without Barrett's which involves mostly perigastric nodes comprising the greater curvature's in 16.5%. The role of total gastrectomy should be questioned. These data deserve further investigation to improve surgery but possibly also surveillance programs. Disclosure: All authors have declared no conflicts of interest.
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